﻿<!DOCTYPE html>
<html lang="en">
<#include "../include/resource-head.ftl"/>
<#assign active='siteAdd'/>
<body>
<#include "../include/common-top.ftl"/>
<div class="main-container" id="main-container">
    <div class="main-container-inner">
    <#include "../include/common-menu.ftl"/>
        <div class="main-content">
            <div class="page-content">
                <div class="col-xs-12">
                    <div class="row-fluid">
                        <div class="widget-box">
                            <div class="widget-header widget-header-blue widget-header-flat">
                                <h4 class="lighter">
                                    <i class="icon-plus"></i>信息修改
                                </h4>
                            </div>
                            <div class="widget-body">
                                <div class="widget-main">
                                    <div class="step-content row-fluid position-relative">
                                        <form class="form-horizontal" action="/info/update" method="post"
                                              enctype="multipart/form-data">
                                            <input type="hidden" name="id" value="${info.id}">
                                            <div class="col-xs-4">
                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">血压（收缩压）</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="xyss" required
                                                               value="${info.xyss}"/>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">血压（舒张压）</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="xysz"
                                                               value="${info.xysz}" required/>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">心率（次/分钟）</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="xl"
                                                               value="${info.xl}" required/>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">血糖（空腹）</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="xt"
                                                               value="${info.xt}" required placeholder=""/>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">身高（cm）</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="sg"
                                                               value="${info.sg}" required/>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">体重（kg）</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="tz"
                                                               value="${info.tz}" required/>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">BMI</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="bmi"
                                                               value="${info.bmi}" required/>
                                                    </div>
                                                </div>
                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">胆固醇（mmol/L）</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="dgc"
                                                               value="${info.dgc!}" required/>
                                                    </div>
                                                </div>

                                            </div>
                                            <div class="col-xs-4">


                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">视力（左眼）</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="slz"
                                                               value="${info.slz}" required/>
                                                    </div>
                                                </div>


                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">视力（右眼）</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="text" class="width-100" name="sly"
                                                               value="${info.sly}" required/>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">辨色能力</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <select class="width-100" name="bsnl">
                                                            <option value="正常">正常</option>
                                                            <option value="稍弱" <#if info.bsnl == '稍弱'>selected</#if>>
                                                                稍弱
                                                            </option>
                                                            <option value="弱" <#if info.bsnl == '弱'>selected</#if>>弱
                                                            </option>
                                                        </select>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">心脏</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <select class="width-100" name="xz">
                                                            <option value="正常">正常</option>
                                                            <option value="异常" <#if info.xz == '异常'>selected</#if>>异常
                                                            </option>
                                                        </select>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">肺脏</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <select class="width-100" name="fz">
                                                            <option value="正常">正常</option>
                                                            <option value="异常" <#if info.fz == '异常'>selected</#if>>异常
                                                            </option>
                                                        </select>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">四肢</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <select class="width-100" name="sz">
                                                            <option value="正常">正常</option>
                                                            <option value="异常" <#if info.sz == '异常'>selected</#if>>异常
                                                            </option>
                                                        </select>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-5 control-label no-padding-right">淋巴</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <select class="width-100" name="lb">
                                                            <option value="正常">正常</option>
                                                            <option value="异常" <#if info.lb == '异常'>selected</#if>>异常
                                                            </option>
                                                        </select>
                                                    </div>
                                                </div>


                                            </div>

                                            <div class="col-xs-4">


                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-3 control-label no-padding-right">甲状腺</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <select class="width-100" name="jzx">
                                                            <option value="正常">正常</option>
                                                            <option value="异常" <#if info.jzx == '异常'>selected</#if>>异常
                                                            </option>
                                                        </select>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-3 control-label no-padding-right">嗅觉</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <select class="width-100" name="xj">
                                                            <option value="正常">正常</option>
                                                            <option value="稍弱" <#if info.xj == '稍弱'>selected</#if>>稍弱
                                                            </option>
                                                            <option value="弱" <#if info.xj == '弱'>selected</#if>>弱
                                                            </option>
                                                        </select>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-3 control-label no-padding-right">血常规</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <select class="width-100" name="xdt">
                                                            <option value="正常">正常</option>
                                                            <option value="异常" <#if info.xdt == '异常'>selected</#if>>异常
                                                            </option>
                                                        </select>
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-3 control-label no-padding-right">彩超</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <select class="width-100" name="cc">
                                                            <option value="正常">正常</option>
                                                            <option value="异常" <#if info.cc == '异常'>selected</#if>>异常
                                                            </option>
                                                        </select>
                                                    </div>
                                                </div>
                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-3 control-label no-padding-right">血常规</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="file" name="icon" required class="form-control">
                                                    </div>
                                                </div>

                                                <div class="form-group has-info">
                                                    <label class="col-xs-12 col-sm-3 control-label no-padding-right">彩超</label>
                                                    <div class="col-xs-12 col-sm-5">
                                                        <input type="file" name="icon2" required class="form-control">
                                                    </div>
                                                </div>


                                            </div>



                                            <hr/>
                                            <div class="row-fluid wizard-actions">
                                                <button class="btn btn-info" type="button"
                                                        onclick="javascript:history.go(-1)">返回
                                                </button>
                                                <button class="btn" type="reset">重置</button>
                                                <button class="btn btn-success" type="submit">提交</button>
                                            </div>
                                            <div class="form-group has-info">
                                                <img class="col-sm-6" src="${info.ccpath!}">
                                                <img class="col-sm-6" src="${info.xdtpath!}">
                                            </div>


                                        </form>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div><!-- /.page-content -->
    </div><!-- /.main-content -->
</div><!-- /.main-container -->
</body>
<#include "../include/resource-script.ftl"/>
</html>

